Cardiovascular and Autonomic Reflexes in Haemodialysis Patients

Abstract

1. Blood pressure and heart rate responses to head-up tilt, standing, the Valsalva manoeuvre, sustained handgrip and cutaneous cold were measured in 27 haemodialysis patients (10 of whom had episodes of haemodialysis-induced hypotension) and 15 control subjects to assess autonomic nervous function. Plasma noradrenaline levels were measured at rest and during head-up tilt. 2. Mean resting supine blood pressure, heart rate and plasma noradrenaline levels were higher in haemodialysis patients than in the control subjects. There was no fall in blood pressure during head-up tilt or standing. The ratio of the R--R intervals of the thirtieth and the fifteenth heart beat after standing (30:15) was lower in the patients; this may be related to their higher resting heart rate. Head-up tilt raised plasma noradrenaline levels in both groups. Heart rate responses to the Valsalva manoeuvre were similar in the patients and control subjects. 3. Systolic blood pressure and heart rate responses to sustained handgrip were similar in both groups. Diastolic and mean blood pressure changes, however, were lower in the patients. The blood pressure and heart rate responses to cutaneous cold were similar in the patients and control subjects. 4. We conclude that generalized autonomic nervous dysfunction does not appear to cause haemodialysis-induced hypotension in patients with chronic renal failure on maintenance haemodialysis.

Cardiovascular responses in rats with glycerol‐induced acute renal failure

“…These include defective function of sweat glands (Hennessy & Siemsen, 1968), abnormal response to the Valsalva manoeuvre (Ewing & Winney, 1975;Campese, Romoff, Levitan, Lane & Massry, 1981), vagal neuropathy (Burgess, 1982;Endre, Perl, Kraegen, Charlesworth & Macdonald, 1982) and reduced pressor response to sustained hand grip exercise (Ewing & Winney, 1975;Campese et al, 1981). Impairment of autonomic function has also been implicated in haemodialysis-induced hypotension (Kersh, Kronfield, Unger, Popper, Cantor & Cohn, 1974); although the importance of any defect in the autonomic nervous system in this disorder has been disputed (Naik, Mathias, Wilson, Reid & Warren, 1981).…”

Effect of Haemodialysis on the Control of the Circulation in Patients with Chronic Renal Failure

“…Resting plasma noradrenaline levels were increased in haemodialysis patients as has been previously noted [39], The low molecular weight of noradrenaline suggests that it may be removed during haemodialysis, and this might contribute to haemodialysis-induced hypotension if plasma levels fall [40]. Previous studies of the effect of dialysis on plasma noradrenaline levels have produced conflicting results [1,41].…”

Cardiovascular responses to upright tilting in hypertensive patients, with and without renal impairment and before and following nisoldipine treatment.

“…Following nisoldipine treatment, the baseline (Lazarus et al, 1973;Lilley et al, 1976;Naik et al, 1981).…”

“…When hypertension is complicated by renal impairment, orthostatic tolerance may be even further reduced (Lilley et al, 1976). However, it is not clear as to whether the diminished responses that have been reported in hypertensive patients with renal disease are largely the result of renal dialysis as this has been shown to impair orthostatic tolerance (Kim et al, 1979;Maher et al, 1965;Naik et al, 1981). Furthermore, in the previous studies on patients with hypertension and renal impairment, responses to standing and upright tilting have been compared only with those in normotensive healthy subjects or uraemic patients rather than with comparable hypertensives who did not have renal involvement.…”